How can the pleating or puckering of excess skin around the areola be reduced after implant removal? (photos)

You certainly have had numerous revisions, so another revision to the tissues is probably not the best choice.  You may want to try some filler.  It will be temporary but may improve it some, although fat grafting should have improved it as well. You may be a candidate for lasers to improve the skin quality, but an examination would be needed to determine if that would be a good choice for you.

Thank you for your pictures and questions. To be perfectly honest, if the course of your surgery has been that rocky with over 12 revisions and this is the result you have, I would tell you to quit while you are ahead. You do have some asymmetry with shape and some pleating around the nipple, but compared to other situations similar to yours I have seen, you have an excellent result. There could be some minor interventions or scar revisions possible, but with every effort at that, there is a possibility to make things worse. I think in this situation, "perfect is the enemy of good."Hope this helps!

Given all of your surgeries, for now, I would suggest that you live with your results. I know that they look awful to you, but to an outside observer, the pleating is very subtle. If you are truly miserable, you could try filler or fat grafting. Or maybe laser to smooth out the skin. Schedule an appointment with a board certified plastic surgeon to be assessed in person and discuss. Best of luck.